Can we really do computer-aided drug design?

In this article, we discuss what we mean by 'design' and contrast this with the application of computational methods in drug discovery. We suggest that the predictivity of the computational models currently applied in drug discovery is not yet sufficient to permit a true design paradigm, as demonstrated by the large number of compounds that must currently be synthesised and tested to identify a successful drug. However, despite the uncertainties in predictions, computational methods have enormous potential value in narrowing the range of compounds to consider, by eliminating those that have negligible chance of being a successful drug, while focussing efforts on chemistries with the best likelihood of success. Applied appropriately, computational approaches can support decision-makers in achieving multi-parameter optimisation to guide the selection and design of compounds with the best chance of achieving an appropriate balance of properties for a drug discovery project's objectives. Finally, we consider some approaches that may contribute over the next 25 years to improve the accuracy and transferability of computational models in drug discovery and move towards a genuine design process.